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Don’t be Caught off Guard… Some Things Medicare Doesn’t Cover

Long-term care

Although it is potentially one of the biggest expenses older Americans may face, Medicare does not pay for long-term care. A private room in a nursing home costs more than $100,000 a year and a stay in an assisted living facility about half that much, according to the 2018 Genworth Cost of Care Survey.

Possible solutions include stand-alone long-term care insurance or a life insurance policy with an LTC rider; allocating a portion of an investment portfolio or annuity for potential LTC costs; or moving to a retirement community that provides all levels of care (which most likely comes with a hefty entrance fee).

Dental care

Dental expenses may tend to increase with age. Think gum disease or crowns and root canals…all expensive procedures. Dentures are not covered either.

Consider buying supplemental dental insurance, joining a membership program that offers dental discounts or enrolling in a Medicare Advantage plan. Even those solutions have limits on the number of visits and procedures that are covered and are subject to an annual maximum, though.

Routine vision care

If you were accustomed to employer-provided health-care coverage, it may be a shock to learn that Medicare does not cover routine vision care. This would include things such as eye exams, glasses, contact lenses or prescription sunglasses, except in cases such as annual eye exams for those with diabetes or glasses following certain kinds of cataract surgery.

Most Medicare Advantage plans include vision care or those with traditional Medicare can purchase a supplemental vision insurance plan, often paired with dental insurance.

Hearing aids

The chance of hearing loss increases with age, and hearing aids can cost up to $3,000 per ear. Some Medicare Advantage plans cover hearing aids.

Costco offers some lower-cost alternatives for members. And the Food and Drug Administration has been authorized to create a new class of personal hearing devices that will soon be available over-the-counter.

Deductibles and co-pays

Traditional Medicare consists of Part A, which covers hospitalization, and Part B, which covers outpatient services and doctors’ fees. Part A is free for most retirees and spouses who paid FICA payroll taxes for at least 10 years. Part B has a standard monthly premium of $134 per month in 2018. But both Parts A and B have annual deductibles and co-payments.

A supplemental Medigap policy can be purchased to fill the gaps or enroll in a less-expensive Medicare Advantage plan that usually offers additional benefits in exchange for using in-network medical facilities and providers.

Prescription drugs

Basic Medicare doesn’t cover out-patient prescription drugs.

Choose a stand-alone Part D prescription drug plan or enroll in a Medicare Advantage plan with drug coverage. But some retirees don’t need to bother if they have retiree health coverage that includes prescription drug coverage or if they continue to work and have prescription drug coverage in their current employer or their spouse’s employer. They can enroll in a Medicare Part D plan penalty-free during a special enrollment period if their existing drug coverage ends.

Medical care overseas

Medicare usually doesn’t cover health care while you’re traveling outside the U.S. There are some exceptions, including some cases where Medicare Part B (Medical Insurance) may pay for services that you get on board a ship within the territorial waters adjoining the land areas of the U.S.

The best bet may be to buy travel insurance that includes medical coverage. Those with health issues should make sure their preexisting conditions are covered, even if they have to pay extra.

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Long-term care

Although it is potentially one of the biggest expenses older Americans may face, Medicare does not pay for long-term care. A private room in a nursing home costs more than $100,000 a year and a stay in an assisted living facility about half that much, according to the 2018 Genworth Cost of Care Survey.

Possible solutions include stand-alone long-term care insurance or a life insurance policy with an LTC rider; allocating a portion of an investment portfolio or annuity for potential LTC costs; or moving to a retirement community that provides all levels of care (which most likely comes with a hefty entrance fee).

Dental care

Dental expenses may tend to increase with age. Think gum disease or crowns and root canals…all expensive procedures. Dentures are not covered either.

Consider buying supplemental dental insurance, joining a membership program that offers dental discounts or enrolling in a Medicare Advantage plan. Even those solutions have limits on the number of visits and procedures that are covered and are subject to an annual maximum, though.

Routine vision care

If you were accustomed to employer-provided health-care coverage, it may be a shock to learn that Medicare does not cover routine vision care. This would include things such as eye exams, glasses, contact lenses or prescription sunglasses, except in cases such as annual eye exams for those with diabetes or glasses following certain kinds of cataract surgery.

Most Medicare Advantage plans include vision care or those with traditional Medicare can purchase a supplemental vision insurance plan, often paired with dental insurance.

Hearing aids

The chance of hearing loss increases with age, and hearing aids can cost up to $3,000 per ear. Some Medicare Advantage plans cover hearing aids.

Costco offers some lower-cost alternatives for members. And the Food and Drug Administration has been authorized to create a new class of personal hearing devices that will soon be available over-the-counter.

Deductibles and co-pays

Traditional Medicare consists of Part A, which covers hospitalization, and Part B, which covers outpatient services and doctors’ fees. Part A is free for most retirees and spouses who paid FICA payroll taxes for at least 10 years. Part B has a standard monthly premium of $134 per month in 2018. But both Parts A and B have annual deductibles and co-payments.

A supplemental Medigap policy can be purchased to fill the gaps or enroll in a less-expensive Medicare Advantage plan that usually offers additional benefits in exchange for using in-network medical facilities and providers.

Prescription drugs

Basic Medicare doesn’t cover out-patient prescription drugs.

Choose a stand-alone Part D prescription drug plan or enroll in a Medicare Advantage plan with drug coverage. But some retirees don’t need to bother if they have retiree health coverage that includes prescription drug coverage or if they continue to work and have prescription drug coverage in their current employer or their spouse’s employer. They can enroll in a Medicare Part D plan penalty-free during a special enrollment period if their existing drug coverage ends.

Medical care overseas

Medicare usually doesn’t cover health care while you’re traveling outside the U.S. There are some exceptions, including some cases where Medicare Part B (Medical Insurance) may pay for services that you get on board a ship within the territorial waters adjoining the land areas of the U.S.

The best bet may be to buy travel insurance that includes medical coverage. Those with health issues should make sure their preexisting conditions are covered, even if they have to pay extra.